CIO Council Pandemic Preparedness Committee

1. Loma Linda University, California, April 2009 July 27, 2009 CIO Council Pandemic Preparedness Committee

2. Global Update, July 27, 2009

3. What a difference two months makes April 2009 June 2009

5. Distribution of US Cases, July 4, 2009

6. Florida, H1N1v by age

7. World cases, 23 June 2009

8. Australia, H1N1v by age

9. Consultations made to UK General Practitioners Source: Peter Osborn and Dr. Tony Yardley-Jones , UK

10. Global H1N1v fatalities, April-July 2009 Source: Peter Osborn and Dr. Tony Yardley-Jones , UK

11. Source: Peter Osborn and Dr. Tony Yardley-Jones , UK

12. The second wave in 1918 was the killer. Second wave, Fall 1918 First wave, Spring-Summer 1918 Third wave, Winter-Spring 1919 Between 50 and 100 million people died worldwide in a 20-week period in 1918-19.

13. The Argentina cautionary tale • Case fatality rate higher than global average • Absenteeism in some sectors exceeding 40% • Connected to Florida, US via Miami, Orlando, NY gateways People stand in line to vote in Argentina’s national election. The ruling party (Peronist Party) lost badly, due in part to the government’s perceived mishandling of the swine flu situation, and the Health Minister resigned after the election.

14. Swine H1 Morbidity and Mortality • More Americans died of swine influenza (17) this month (July - 136),than in the entire months of April, May and June combined(127).* • In early July, worldwide, there were more than 60,000 confirmed infections, with roughly 230 deaths. • Today, worldwide, there are over 140,000 cases with over 700 deaths.+ That explosive growth occurred in less than three weeks. • That is a case fatality rate of .5%, placing it in the “moderate” Category 2 pandemic category. • Any shift toward greater lethality could move the virus to Category 3 status. • * Sources: CDC, CBS News • + Source: Associated Press

15. What might this virus do? • It might become resistant to Tamiflu. • It might reassort with other flus and become even easier to catch. • It might reassort with H5N1 in the Middle East (Egypt, Turkey, Pakistan), Africa (Nigeria), Asia (Indonesia, China, Vietnam, Cambodia) and acquire extreme lethality. • Or it could be overpowered by seasonal flu. • “Nearly 100 percent of the influenza viruses being detected now (US) are novel H1N1 viruses.” – CDC, July 17, 2009

16. H1N1v has won King of the Mountain in the US.

17. Official UK estimates for planning purposes, H1N1v (Source and graphic: BBC)

18. Official UK planning estimates of mortality, compared with 1957 and 1968 pandemic deaths. (Source and graphic: BBC)

19. Note: Britain is one-fifth the population of the United States.

20. The Southern Hemisphere holds the key. • It is their flu season now. It started in April and stretches to October, when ours begins. • If swine H1 gains a strong foothold and becomes the dominant flu strain in the Southern Hemisphere, it will also do so here. DONE. • If the pandemic virus does not defeat seasonal H1N1 and H3N2 in influenza’s game of “king of the mountain” Down Under, it could still emerge triumphant here. • UPDATE: Over 90% of all typed Southern Hemisphere flu cases are the pandemic strain.

21. Worldview, April-July 2009

22. Tallahassee, FL

23. California

24. Texas

25. New York Bad mask wearing!

26. Camp Modin, Maine, July 22, 2009

27. Mexico City

28. Mexico City

29. Cancun, Mexico

30. El Salvador

31. Buenos Aires, Argentina

32. Buenos Aires, Argentina

33. Scotland

34. Kuwait City

35. Cairo, Egypt

36. Mecca, Saudi Arabia Umrah

37. Natanya, Israel

38. Bangkok, Thailand

39. Incheon, South Korea

40. Hong Kong

41. Chengdu, China

42. Auckland, New Zealand

43. Australia

44. Shanghai, China

45. Pandemic Planning for Agencies

46. BIG rule of thumb: • If your agency or organization has not formulated a pandemic planning team, that organization is NOT PREPARED FOR A PANDEMIC. • If your agency or organization has not exercised its pandemic plan via a tabletop exercise or stronger simulation, that organization is NOT PREPARED FOR A PANDEMIC.

47. What would Ike do? • “The plan is useless – it’s the planning that’s important.” • Ike's point is that events will never go according to The Plan -- but a mature planning process will help you prevail.  • Believe me, no one in State government is smarter than Ike on this matter. No one.

48. Add context: What will happen all around us?

49. The pandemic plan for organizations • PLAN ONE CATEGORY HIGHER • Create corporate/agency pandemic planning team • Prepare agency succession plan • Ensure “retail business/government” ops continue • Acquire protective equipment • Monitor employee absenteeism • Cross-train your staff • Design, implement and support Work at Home plans • Prepare for supply chain failures • Prepare Communications Plan • Teach protective actions • Gain an understanding of influenza and how it works • Leverage this planning for similar scenarios • Update DR and COOP plans NOW, as existing COOP plans without pandemic modifications will NOT WORK in a pandemic.

50. There should be already in place, a pandemic planning team • Legal • Human Resources • Training Development • Information Technology • Procurement/Purchasing • Communications/Press Secretary • Facilities/Maintenance/janitorial • And at the top….. The CEO, agency head, or second in command. • If there isn’t one… they’re not ready for a pandemic.